Online Medical Chats

Heart Care 101: Signs, Symptoms, Management and Treatment

Romi (Moderator) - 11:23 AM:Welcome! Today’s chat: Heart Care 101: Signs, Symptoms, Management and Treatment will begin shortly. Please start submitting your questions and Philip Krause, MD, cardiologist will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit our Cardiovascular pages on our website.
We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

Dr. Philip Krause (NorthShore) - 11:28 AM:Good Day to all.
My name is Dr. Philip B. Krause.
I am an Interventional Cardiologist and the Director of the Section of Cardiology here at Skokie Hospital.
I have been an Attending Cardiologist since 1994 and spend my day seeing patients in the hospital, in the office, and performing procedures including coronary angiography, PTCA, stent placement, as well as treating patients with coronary artery disease, arrhythmias and heart failure. My colleagues and I are available 24 hrs per day for emergency consultation and procedures.
I look forward to addressing your questions.

Teresa (Chicago, IL) - 11:31 AM:At only 27 I was diagnosed with A-Fib. My cardiologist prescribed FLECAINIDE for EACH episode due to my age. That was ten years ago. How/when do I know if I need to switch from the "pill-in-the-pocket" method to a preventative drug such as a BETA BLOCKER?

Dr. Philip Krause (NorthShore):We typically reserve treatement with Beta blockers such as metoprolol and atenolol for patients with more frequent arrhythmias ( daily to weekly) and palpitations. Calcium channel blockers such as diltiazem or verapamil may also be used in place of beta blockers.
If the symptoms are rare and you have episodes of afib less than once every month, you may be well served with pill-in -the pocket approach.
However, you should follow up with your personal physician and a cardiologist or electrophysiologist at least yearly.
Echocardiiolgram and stress testing may be indicated especially 12 yrs from now approaching menopause.

Dr. Philip Krause (NorthShore):Hi Gaby,
It's hard to know if these symptoms are cardiac related. Wthout knowing your age or past medical history, the diffential diagnosis my include many options.
You should see your personal physician to check lab tests and perform a full history and physical - sooner than later.
-Dr. Krause

Maria (Evanston, IL) - 11:38 AM:I’ve always had GI issues and frequently suffer from heart burn. How closely tied is this to heart problems? How can I spot the difference?

Dr. Philip Krause (NorthShore):Hi Maria:
Without knowing your age or past history, it is diffucult to discern between cardiac and GI related causes of heartburn.
However, in women, especially near menopause or with diabetes, the symptoms of heartburn may reflect coronary insufficiency or artery blockage, regardless of the GI history.
YHou should make an appt with your personal physician to assess your coronary disease risk factors: smoking, family history, high blood pressure, and cholesterol.
You may need a stress test to check for coronary disease and assess your exercise tolerance as well as noting if this may reproduce your symptoms.
If the cardiac tests are negative(normal), ways to avoid reflux/ heartburn include stopping coffee intake of any kind(including decaf), and avoid chocolate and mints.
-Dr. Krause

Kelly (Gurnee, IL) - 11:45 AM:Is heart disease more common among men or women? Are there particular ages groups that are most affected?

Dr. Philip Krause (NorthShore):Hi Kelly:
Good question.
Heart disease is the most common killer of
Americans be it male or female.
The risk for heart disease rises for males after age 45 and for females after age 55.
This is due to the protection women get from estrogen and progesterone in the pre-menopausal years.
Dr. Krause

Sam (Wilmette, IL) - 11:48 AM:I tend to experience a lot of pressure and gas both before and during PVS’s. Is this discomfort normal? Is that what causes the skips?

Dr. Philip Krause (NorthShore):Sam
Do you mean PVC's?
If so, if the pressure and gas sensation is in the chest or upper abdomen, you may need a stress test with imaging to check for a cardiac/coronary cause for your discomfort.
PVC's may or may not cause palpitations but not usually pressure sensation.
You should discuss this with your personal physician.

Amy (Northbrook, IL) - 11:52 AM:Is there a difference between a heart attack and cardiac arrest?

Dr. Philip Krause (NorthShore):amy
Yes, there is a difference.
A heart attack refers to a blockage in one or more of the coronary arteries supplying the heart with blood and oxygen. when the heart is deprived of blood and oxygen, the pt develops ecg changes and symptoms of chest pain or pressure,squeezing, tightness, nausea or trouble breathing/sweating.
This can be treated if the pt arrives to the ER quickly with cardiac cath and ptca /stents aloing with medication.
A cardiac arrest refers to an arrhythmia or very fast or very slow heartbeat that causes the blood pressure to fall and couse the person to pass out.
if the arrhythmia is not corrected through electric shock (defibrillation) or use of a pacemaker after cpr to establish blood flow,
the person will not survive.
Cardiac arrest may occur during a heart attack or in patients with weakened heart muscle for other reasons such as cardiomyopathy.
This is why it is importnat for people to learn CPR and to use AED (automatic external defibrillator)

Carol (Winnetka, IL) - 11:59 AM:My father had a heart attack about 10 years ago. What are the long-term affects on the rest of the body?

Dr. Philip Krause (NorthShore):Carol
The long term effects depend on the residual heart muscle function (the ejection fraction or EF) and other risk factors.
He would need close follow up with his primary MD and a cardiologist to prevent another episode.
Dr. Krause

Robert (Evanston, IL) - 12:01 PM:I have a family history of heart disease. What are some the risk factors I should be on the look out for?

Dr. Philip Krause (NorthShore):Hello Robert_
Besides Family history which is one of the most imporotant but non modifiable risk factors, they include
High Blood pressure
High cholesterol
Smoking history
Diabetes
male age >45
Female age >55.
You should be on the lookout for symptoms of chest pressure, heaviness, shortness of breath, and change in exercise tolerance.
Ask your doctor if you need a stress test due to family history.
Dr. Krause

Adam (Highland Park, IL) - 12:04 PM:What do I need to do if I think that I am suffering from a heart attack? How important is time?

Dr. Philip Krause (NorthShore):"Time is muscle"
The longer a person waits to get treated, the worse the outcome and the worse the permanent amount of irreversible heart damage.
If you are having discomfort in the chest, back or arm or have nausea or sweating or trouble breathing, you should call 911 immediately for transport to the closest ER.

Mark (Wilmette, IL) - 12:06 PM:Until a few years ago I was genuinely in good health. In 2009, I went to the ER with severe chest pressure and shortness of breath. Turns out my arteries were between 80-90% blocked so I had surgery. My recovery went well the first year, but since then I have been developing other health concerns – diabetes and heart disease to name a few. I am wondering if any of this was the cause of my surgery and what I can do to feel better now? Thanks.

Dr. Philip Krause (NorthShore):Mark
Sounds like the Diabetes is the cause for progressive heart disease.
Wiithout seeing your coronary angiogram, it is hard to discern any surgical issues as the etiology.
If you remain symptomatic, you need to follow up with your primary MD and cardiologist to assess for possible stress testing and potential cardiac cath. You may be a candidate for ptca or stent placement to the bypass grafts or other coronary arteries.
You should also review your meds with the MD and check your sugars regularly.
Stay on a strict diabetic diet.
Dr. Krause

Karen (Lake Forest, IL) - 12:09 PM:My 17-year old son has recently complained about chest pain. He is very active and fit, so I don’t think it would be anything serious, although we are planning to go to the doctor about it next week. He said he experiences intense pressure, often lasting up to 15 minutes in his chest followed by muscle soreness. Should he be seeing a cardiologist instead of his pediatrician for this?

Dr. Philip Krause (NorthShore):Karen
If your son is having pressure, the primary MD should be notified immediately for an urgent appointment today.
He should avoid exercise.
Call the Doctor today to have him evaluated ASAP.
They will need to know if the symptoms occured at rest or wiith activity
Dr. Krause

Nancy (Libertyville, IL) - 12:11 PM:How much does your diet have to do with the amount of plaque build-up you can have in your arteries? Can eating a healthier diet limit this build-up and reduce your risk for developing heart disease?

Dr. Philip Krause (NorthShore):Yes
Cholesterol and fat in the diet are leading causes of plaque build up in the arteries.
Persons with family history of coronary disease, smokers and those with diabetes are particularly at risk.
My patient s are instructed to follow a strict low choletserol low fat diet which is detailed on the ADA and =AHA web sites.
Eating a healthier diet can reduce cholesterol and reduce risk.

David (Arlington Heights, IL) - 12:13 PM:My cardiologist recently told me that one of my valves doesn’t close properly, but that it wasn’t anything to worry about. How can this not be something serious? I am getting really stressed out about it, which I think it causes my heart to skip. What can I do?

Dr. Philip Krause (NorthShore):David
Heart valves can leak or can be stenotic with limitation of movement.
You should ask your cardiologist which valve is the probleme and whether is has leaking(regurgitation) or is narrow (stenotic).
You may also want to ask the severity of the problem: mild, moderate or severe.
If mild, an echocardiogram in follow up is helpful.
Aslo ask if you antibiotics when visiting the dentist.

Valerie (Chicago, IL) - 12:16 PM:My mother had very frequent blood clots during her life and passed away recently from heart complications. I just started getting blood clots. What heart conditions can this lead to, if any? Can I do anything to avoid them?

Dr. Philip Krause (NorthShore):Valerie
The location of the blood clots is importnat and whether they are in the arteries or veins.
You should ask your Doctor if you need to see a hematologist as this may be a familial / genetic problem.
You should also ask if you need aspirin or other blood thinners to prevent future problems.

Sarah (Glenview, IL) - 12:19 PM:My husband just turned 56 and has a family history of heart disease. He’s very healthy and doesn’t seem to think it will affect him, and if it does do not until he’s older. I’ve heard that stress testing is a good, non-invasive way to test for blocked arteries. Are there other tests he should consider, even if he’s healthy?

Dr. Philip Krause (NorthShore):Sarah
Indeed, the risk for coronary goes up in males over age 45 especially with family history.
As detailed in prior questions today, he should be evaluated for other risk factors including Diabetes, High blood pressure, full choolesterol profile, and smking.
he may well benefit from a stress test with imaging to look for inducible ischemia or diminished blood flow to the heart.
he may aslo consider coronary CT as an alternative but the stress test gives important functional information.

Romi (Moderator) - 12:20 PM:Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

Leslie (Deerfield, IL) - 12:23 PM:I just started noticing that after doing light exercise I often get dizzy and have significant shortness of breath. It also sometimes feels like my heart is pumping a lot harder. I’m scared to do more strenuous activities because I fear that I’ll faint. What could this be?

Dr. Philip Krause (NorthShore):Leslie
Your symptoms might be related to Coronary artery disease or lung disease. You may also be dehyrated causing dizziness.
you may also be having a rhythm problem causing dizziness.
If you are having symptoms, you should stop exercise immediately and call your physician TODAY to report these symptoms. They may want to see you in the office this week or send you to the ER based on a description of your symptoms in more detail.
Do not delay.

Tiffany (Evanston, IL) - 12:26 PM:My parents have struggled with their weight for the last ten years. Just how much does being overweight affect your heart? What are some simple changes they can make to their daily routine to trim down?

Dr. Philip Krause (NorthShore):Tiffany-
Obesity is a significant problem as it can lead to all forms of heart disease, diabetes, and stroke.
Initially, they reduce portion size and eat LESS. They should cut the carbohydrate or starch intake in half by avoiding bread, pasta and potatoes.
They should avoid dessert.
Limit trips to the restaurants/fast foods.
A local dietician in the NorthShore system can help get them on the straght and narrow path.

Gary (Northbrook, IL) - 12:29 PM:I just had triple bypass surgery. For the last couple of weeks I have been very, very tired. What can I expect over the next few months and years in my recovery?

Dr. Philip Krause (NorthShore):Gary
Call your cardiologist and heart surgeon to discuss your fatigue.
If this is improving, it may take several weeks before feeling less tired.
Ask about a cardiac rehab program.
Also, this can occur with fluid buildup after surgery so you may need an exam and follow up echocardiogram.
Call the Doctors this week.

Dr. Philip Krause (NorthShore):Don
3 blood thnners are availble for treatment of atrial fibrillation including xarelto, coumadin/warfarin, and pradaxa
I have the most experience with coumadin which has the advantage of monitoring blood testing and assessment of efficacy of the drug.
The other 2 do not need blood testing but can be an issue of bleeding occurs on the drug.
If bleeding compications occur with coumadin, we can give the patient vitamin K to reverse the problem.
That is another advantage of coumadin/warfarin.

Adam (Chicago, IL) - 12:34 PM:I was told I have trivial mitral valve regurgitation, but that it is not serious and the only thing I should do is taking antibiotics if I'm having a dental procedure. I'm a teenager so is this something that I will grow out of and are there any precautions I should take because of this?

Dr. Philip Krause (NorthShore):You should ask the MD when you need a follow up echo.
this may disappear with age.
Peridental prophylaxis is recommended based on the severity of Mitral regurgitation.

Romi (Moderator) - 12:36 PM:Thank you for participating in our online chat today. An online transcript will be available shortly. To learn more about NorthShore’s Cardiovascular services, visit our website.